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PubMed1998

Family practice night-call frequency: 1981-1997.

BACKGROUND AND OBJECTIVES: Night call has both service and educational value. This study examined trends in night-call frequency from 1981-1997. Our hypothesis was that night-call frequency is decreasing in family practice residency programs. METHODS: We reviewed the Directory of Family Practice Residency Programs from 1981, 1989, and 1997 and entered into a database information about call frequency from all of the programs in each year. In-house night-call frequency and frequency of home call requiring other trips to the hospital were combined to determine total calls per year. RESULTS: The mean number of total calls for PGY-1 residents was 190, 124, and 104 for each cohort year, respectively (1981, 1989, 1997). PGY-2 total calls were 160, 96, and 74. PGY-3 total calls were 151, 73, and 57. For all years of residency, total calls in 1997 were fewer than for 1981 and 1989. CONCLUSIONS: Family practice residents have less night call now than in 1981 or 1989. The educational consequences of decreasing night call should be evaluated.

Emergency Medical Services↗

PubMed1983

Abdominal pain in a university family practice setting.

Abdominal pain is one of the most common complaints in the family practice setting. Abdominal pain has been the subject of many studies; however, the focus has been on abdominal pain as a final diagnosis rather than as a symptom or presenting complaint. A retrospective audit examined 133 charts of patients 18 years of age or older presenting to the University of Iowa Family Practice Center from July 1976 to October 1978. Abdominal pain, etiology undetermined, accounted for approximately one half of the final diagnoses. The patients tended to be young and female. Almost one half of the patients were seen only once for the problem. Conclusions concerning management are drawn, and suggestions for further studies are made.

Abdomen↗

PubMed1996

Psychiatric consultation for somatizing patients in the family practice setting: a feasibility study.

OBJECTIVE: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs). METHOD: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview with the consulting psychiatrist, the patient, and the GP. A written summary of the consultation was provided to the GP and the patient. A booster session with a GP and psychiatrist was included to evaluate and reinforce the recommendations. RESULTS: The majority of the selected patients agreed to participate after informed consent. An intervention was implemented containing interpersonal techniques, reattribution, clarification, and structuring. GP compliance with recommendations was 100 percent, patient compliance 75 percent. CONCLUSION: A standardized psychiatric consultation for somatizing patients in a family practice setting can be implemented. Several levels of implementation can be distinguished.

Family Practice↗

PubMed2001

Psychosocial training in U.S. internal medicine and family practice residency programs.

PURPOSE: Competence in the psychosocial aspects of medical care is necessary for primary care physicians to function effectively. This study investigated the psychosocial training internal medicine and family practice residents receive in U.S. programs. METHODS: In 1996, program directors of all U.S. internal medicine (IM) and family practice (FP) residency programs were surveyed regarding the format, content, and quantity of psychosocial training provided in their programs, their opinions on topics related to psychosocial training, and demographics of their programs. RESULTS: The response rate was 61%. Ninety-nine percent of FP and 62% of IM program directors reported requiring at least one psychosocial training experience. Family practice programs required an average of 352 hours (SD +/- 175; range 27-2,664) of psychosocial training compared with 118 hours (SD +/- 272; range 0-1,050) for IM programs. Most IM and FP program directors expected residents to achieve at least basic competency in virtually all psychosocial topic areas; however, FP programs provided a greater range of psychosocial experiences. FP program directors most often identified psychologists and IM program directors most often identified internists as providing the most psychosocial training in their programs. Both IM and FP program directors considered lack of curricular time to be the main obstacle to development of psychosocial training. CONCLUSION: Residents' competence in psychosocial areas is important to both IM and FP program directors. However, content and time devoted to psychosocial training vary considerably both within and between program types.

Clinical Competence↗

PubMed1999

Right from the start: the family practice orientation study.

BACKGROUND AND OBJECTIVES: Orientation to a residency program introduces residents to the essential functions of their duties, clarifies expectations, and acclimates them to a new social group. This study identified the orientation goals of family practice residency directors and compared those goals to the perceived needs of first-year family practice residents. METHODS: We surveyed program directors and PGY-1 residents at 100 accredited family practice residency programs. Questionnaires obtained descriptive information about orientation programs and resident demographics and assessed directors' goals and residents' needs from orientations. RESULTS: The orientation goal ranked most highly by directors was development of group cohesion. The need ranked most highly by residents was introduction to call duties and inpatient problems. Ranked responses of each group were not well associated. CONCLUSIONS: The orientation goals of program directors and the reported orientation needs of residents were poorly associated. Most directors chose nonclinical areas as their most important goals for orientation. In contrast, most residents valued clinically related information during orientation to residency.

Family Practice↗

PubMed1997

Long-term attendance at a family practice teaching unit. Qualitative study of patients' views.

OBJECTIVE: To identify the factors that contribute to patients' long-term attendance at a family practice teaching unit. DESIGN: Qualitative method of focus groups. SETTING: A community-based family practice teaching unit in southwestern Ontario. PARTICIPANTS: Patients who had been coming to St Joseph's Family Medical Centre for more than 15 years were purposefully selected to participate. METHOD: Five focus groups composed of patients who had been affiliated with one of the three practices at the Centre for more than 15 years explored factors contributing to long-term attendance. MAIN FINDINGS: Four key themes were identified as the primary factors contributing to long-term attendance: the relationship context, the team concept, professional responsibility and attitudes, and comprehensive and convenient care. CONCLUSION: The resource-rich era of medical care, during which participants formulated their views and opinions about the factors contributing to their long-term attendance at a family practice teaching unit, has come to a close. The findings of this study provide important information that could help maintain one of the basic tenets of family medicine-continuity of care.

Adult↗

PubMed1997

Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency.

CONTEXT: Medical educators have had a growing sense that proficiency in physical diagnostic skills is waning, but few data have examined the question critically. OBJECTIVE, DESIGN, AND SETTING: To compare the cardiac auscultatory proficiency of medical students and physicians in training. A multicenter cross-sectional assessment of students and house staff. A total of 8 internal medicine and 23 family practice programs of the mid-Atlantic area. PARTICIPANTS: A total of 453 physicians in training and 88 medical students. INTERVENTIONS: All participants listened to 12 cardiac events directly recorded from patients, which they identified by completing a multiple-choice questionnaire. MAIN OUTCOME MEASURES: scores were expressed as the percentage of participants, for year and type of training, who correctly identified each event. Cumulative scores were expressed as the total number of events correctly recognized. An adjusted score was calculated whenever participants selected not only the correct finding but also findings that are acoustically similar and yet absent. RESULTS: Trainees' cumulative scores ranged between 0 and 7 for both internal medicine and family practice residents (median, 2.5 and 2.0, respectively). Internal medicine residents had the highest cumulative adjusted scores for the 6 extra sounds and for all 12 cardiac events tested (P=.01 and .02, respectively). On average, internal medicine and family practice residents recognized 20% of all cardiac events; the number of correct identifications improved little with year of training and was not significantly higher than the number identified by medical students. CONCLUSIONS: Both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events. This study suggests a need to improve the teaching and assessment of cardiac auscultation during generalists' training, particularly with the advent of managed care and its search for more cost-effective uses of technology.

Clinical Competence↗

PubMed1993

Attitudes of Florida family practice residents concerning obstetrics.

BACKGROUND: The cost of liability insurance for obstetrical care and the fear of eventual litigation are reasons commonly cited by family physicians for not delivering babies. METHODS: Separate surveys were mailed to residency directors and third-year residents in Florida family practice residency programs to determine the attitude and practice plans of recently trained family physicians in regard to obstetrics. RESULTS: Three hundred twenty residents completed civilian family practice residency programs in Florida from 1986 through 1990. Only nine (2.8%) delivered babies the first year after residency. The major reasons that third-year residents gave for not planning to deliver babies included fear of being sued and the cost of malpractice insurance. Residents' estimates of first-year insurance costs were 350% higher than actual premiums. Furthermore, residents believed that the risk of being sued for the obstetrics portion of their practice would exceed the risk for the nonobstetric portion. CONCLUSIONS: Residents' estimates of the cost of malpractice insurance and their malpractice risk for delivering babies appear to be greatly exaggerated. These views are primarily obtained from nonresidency sources.

Attitude of Health Personnel↗

PubMed1978

Problems in family practice: the suicidal patient.

Suicidal patients are common in family practice. Risk factors can alert the family physician to persons at unusual risk. Demographic factors, especially those revealing changing social status, recent loss, intentionality, lethality, past history, and high-risk groups, can be rapidly assessed. Viewing suicide as a final common pathway of system dysfunction at any or all major levels-biologic, psychologic, sociocultural-leads to an appreciation of the ubiquitous nature of passive or active "self murder" impulses. Persons depressed for any significant length of time for whatever reasons are potentially suicidal. Thus, the "typical" depression is suicidal but so are persons whose depression is related to drug side effects, primary illness effects, to living in a dysfunctional family system, or to normal grief. Diagnosis requires inquiry about the depth of the patient's depression pain. Treatment takes into account the aforementioned risk factors, plus interventions appropriate to the malfunctioning system.

Age Factors↗

PubMed1979

Family practice finds a home in the hospital.

A brief description of the growth of family practice over the past 10 years into what is now a major specialty leads into a discussion of the implications of this development for hospitals. A fundamental shift of emphasis to family practice in medical education has already occurred and hospital departments of general practice, traditionally administrative in character, are being reorganized into clinical departments with responsibility for assigning privileges and administering educational and peer review programs.

Family Practice↗

PubMed2005

Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice.

BACKGROUND: Predictors of benzodiazepine discontinuation after sending a discontinuation letter by the family practitioner have not been established sufficiently. OBJECTIVE: To identify predictors of short- and long-term discontinuation of benzodiazepine use and relapse in use after a minimal intervention with a discontinuation letter followed by an offer for an evaluation consultation. METHODS: Predictors of benzodiazepine discontinuation and relapse in use were studied by logistic regression analysis and survival analysis within a family practice population of long-term benzodiazepine users (n = 1707) addressed by a discontinuation letter and followed for 21 months. RESULTS: A lower baseline prescription, a shorter duration of use, male gender and use of an agent with a half-life time <24 hours were predictive of complete discontinuation in the short (6 months) and long term (21 months). Multiple agent use at baseline, use of antidepressants at 6 months and benzodiazepine type (anxiolytic/hypnotic) at baseline predicted relapse. Attendance at an evaluation consultation 3 months after the letter was sent was not predictive of discontinuation or relapse. CONCLUSIONS: Amount of baseline use and duration of use are the main determinative characteristics of successful discontinuation. The discontinuation letter intervention is suitable for use with a broad group of long-term benzodiazepine users in family practice and can be used as a first step within a stepped care approach to decrease long-term benzodiazepine use.

Adult↗

PubMed1979

The after-hours call in family practice.

Patient care after hours continues to be an important part of the work of family physicians, in spite of the trend towards increasing Emergency Room utilization. In this paper the literature concerning after-hours care in family practice is reviewed in terms of definition, demography, utilization, morbidity, and patient stereotypes. In the Family Practice Residency Program of the University of North Carolina, 4,760 after-hours calls were recorded over two years by residents and faculty physicians. Seventy-two percent of the calls were handled purely on the telephone with little variation for patient age groups. The overall call rate was 474 calls per 1,000 patients per year. Fever and skin wounds were the most frequent symptoms recorded and respiratory tract infections, minor trauma, and anxiety were the commonest diagnoses. Thirteen percent of the contacts engendered anger or frustration in the physician. A survey of patients calling after hours demonstrated a lack of congruence between physician and patient concerning the main reason for the call in over 30 percent of contacts.

Attitude of Health Personnel↗

PubMed1981

Antimicrobial use review in a family practice setting.

The appropriateness of antimicrobial prescribing habits by resident physicians in a family practice center was evaluated. From a six-month period, 225 antibiotic prescriptions were reviewed retrospectively, in a three-phase study. In the first phase, two physicians determined the validity of the diagnosis and treatment for each case, based on criteria suggested by current literature. In the second phase, the pharmacist investigators compared the prescribed regimens with the established criteria for appropviateness of drug choice, daily dose, dosage interval, and duration of therapy. In the third phase, charts were reviewed to determine if microbial cultures had been ordered. The diagnosis was accepted in 89% of the cases; of those, drug therapy was indicated for 84%, an appropriate drug was prescribed in 89%, daily dose was appropriate in 72%, dosage interval was acceptable in 75%, and duration of therapy was appropriate in 59%. Microbial cultures were commonly ordered for pharyngitis, cystitis, pyelonephritis, and gonococcal urethritis. Cultures were not ordered for tonsillitis, nongonococcal urethritis, prostatis, and pelvic inflammatory disease. The prescribing patterns of a group of family practice residents were found to be in less than full compliance with standards in the literature. However, the importance of this finding is difficult to judge because there have been few such studies in ambulatory care settings and the validity of some of the criteria for appropriateness is not known.

Adolescent↗

PubMedDate not supplied

A family practice residency curriculum in critical appraisal of the medical literature.

This paper reports a five-year experience with a comprehensive curriculum for teaching critical appraisal and practical research skills to family practice residents. The curriculum includes a seminar series in research and medical practice and simulated research projects. Rationale, methods, format, and evaluations of the curriculum are presented. The curriculum prepared graduates to critically review research studies in the professional literature and translate valid conclusions into medical practice. Residents were able to identify potential areas of research interest and acquired additional skills that encouraged continuing education and professional growth.

Curriculum↗

PubMedDate not supplied

Racial disparities in health between white and African American family practice patients: clinical implications.

OBJECTIVE: To identify differences in self-reported health status and prevalence of chronic disease between African American and white patients. STUDY DESIGN: A representative sample of African American and white adult patients from a stratified sample of family practices in North Carolina completed a questionnaire that included self-reported racial status, certain sociodemographic data, health risk factors, chronic conditions, and health status measures. DATA SOURCE: The North Carolina Health Project, a practice-based cohort of adult patients from a representative sample of family practice offices in North Carolina. PRINCIPAL FINDINGS: African Americans report poorer general health status than whites. Obesity insufficient exercise, high blood pressure, and diabetes are more prevalent among African American than white family practice patients, even after adjusting for age, gender, and educational attainment. CONCLUSIONS: This study complements previous evidence of disparities in chronic disease and health risk factors between African Americans and whites, and it highlights specific factors that may be important in the primary care setting. RELEVANCE: By focusing clinical attention on the prevention or treatment of specific factors that are known to be more prevalent among certain racial groups, primary care providers may help to reduce racial differences in healthcare.

Black or African American↗

PubMed1976

Follow-up of rape victims in a family practice setting.

Health care for rape victims traditionally has been crisis oriented, focused solely upon the victim, and provided either by a gynecologist or psychiatrist. A family practice health team, working in a county hospital, offered rape victims and their families crisis counseling in the emergency room, and follow-up care in a family practice clinic. Follow-up of victims markedly increased from 8% before initiation of the program to 86% afterward. Family members of more than half of the victims seen on follow-up received treatment. A wide range of health needs of both victims and their families, not identified in the emergency room, was identified on follow-up visits. In this way emergency care of the rape victim often became an entry point into the health care system. Rape must be viewed as a family's as well as victim's health problem, often demanding a broader service than can be offered by a gynecologist or psychiatrist alone.

Adaptation, Psychological↗

PubMed1998

Teaching outpatient procedures: most common settings, evaluation methods, and training barriers in family practice residencies.

BACKGROUND AND OBJECTIVES: The processes of teaching outpatient procedures in the training of primary care physicians have not been widely studied or standardized. This study identified the most widely used teaching settings, methods of evaluation, and barriers to teaching several key procedures in US family practice residencies. METHODS: A survey was sent to directors of family practice residency programs. Key issues identified in phone survey data of published experts in procedural training were used in developing the survey. RESULTS: Of the 464 residency directors contacted, 342 (73.7%) returned completed surveys. Results showed that the family practice center (FPC) was the most common setting for this teaching. Faculty observation was used as a principal evaluation method in most programs for all procedures. Several barriers to training were identified as "very" or "moderately" important. CONCLUSIONS: While the FPC is the most frequently used setting for training in procedures, significant limitations include problems of low volume, limited methods of evaluation, scheduling difficulties, and lack of faculty interest and skill. Several internal and external strategies may be used to alleviate these problems.

Ambulatory Care↗

PubMed1995

Family practice residents' maternity leave experiences and benefits.

BACKGROUND: A growing number of residents are having babies during residency training. While many businesses are working to improve maternity conditions and benefits for their employees, residency programs are often not prepared to accommodate pregnant residents. This study was conducted to examine the maternity leave experiences of women who delivered infants during their family practice residency training. METHODS: Program directors from each of the 394 family practice residency programs listed in the 1993 Directory of Family Practice Residency Programs were asked to distribute surveys to female residents who gave birth during their residency training and had returned to work by the time of the study. RESULTS: Of 199 known eligible residents, 171 (86%) completed surveys; these women represented 127 programs located in 36 states and Puerto Rico. Only 56.8% of women were aware of their program having a written maternity leave policy. The average length of maternity leave was 8 weeks; 76% had leaves of 10 weeks or less. For many, the maternity leave was derived from more than one source, including vacation, sick time, or a mother-child elective. Nearly all (88.3%) the women breast-fed, and the mean duration of breast-feeding was more than 19 weeks. In general, participants believed that having a baby during residency was somewhat difficult. Problems frequently encountered by women after their return to work included sleep deprivation and tiredness, difficulty arranging for child care, guilt about child care, and breast-feeding. Factors that detracted most from the childbirth experience were too little sleep, problems arranging for child care, and lack of support from the partner, residency faculty, and other residents. CONCLUSIONS: Having a baby during residency is somewhat difficult for the average female resident. Factors that may ease this difficulty include getting adequate sleep and receiving support from one's partner, faculty, and other residents.

Adult↗